chap 18 - disorders of the breast Flashcards
types of tissues in breast
glandular tissues = lobules and ducts
- all women have the same amount of lobules and ducts, around 20-25
stomal supporting tissues
- fat
- fibrous connective tissue
abundant blood supply and lymphatic drainage
Most lymph vessels of breast lead to axillary nodes
Drain to these lymph nodes in the armpit
If breast cancer cells reach axillary nodes and continue to grow, nodes swell and cancer more likely to spread to other organs
Will sample lymph from axillary lymph nodes in order to see if breast cancer has metastasized
puberty
hyperplasia = increase in cell number
Variations in breast size depend on amount of fat and fibrous tissue rather than glandular tissue
Extremely responsive to hormonal stimulation
menstrual cycle
cyclic hyperplasia followed by involution - increase slightly and then gets smaller
pregnancy and lactation
hypertrophic glandular ductal tissues - getting ready to nurse the baby, so the glands get larger
after menopause
sex hormone levels decline, breasts gradually decrease in size
Both estrogen and progesterone go down
most frequent and serious problems
Two main types of breast change
Benign (non-cancerous)
Fibrocystic
Fibroadenoma
Malignant (cancerous)
signs, symptoms and tests
galactorrhea
Visual assessment of breast tissue
- Asymmetry - an increase
- Inversion of nipple
- Changes in texture
- Nipple discharge
Palpitation
Gynecomastia
Associated with increased hormone imbalance
Puberty
Medication
Loss of liver function - estrogen is not being broken down efficiently
Bilateral or unilateral
Mammogram
mammogram
Most useful for postmenopausal women, whose breasts contain more fat and less glandular tissue than breasts of younger women
Baseline: age 35-40
Annually: age 40 thereafter
Mammogram may identify lesions not detected on physical examination
Fatty tissue: appear dark
Fibrous and glandular tissue: appear as white strands
Cysts and benign tumors: well circumscribed
Malignant tumors
Have irregular borders
Frequently contain flecks of calcium
galactorrhea
secretion of milk when you aren’t pregnant
MRI
May be better than mammogram for detecting a small carcinoma
Also detects non-significant changes in the breast
ultrasound
Can differentiate between solid tissue and fluid filled, benign cysts
Screening modality of choice for young women
radiographic/developmental diseases
Embryologically, breasts developed form column of mammary ridges from axilla to upper thighs
Most of the ridges disappear during prenatal development, except for those at the mid thoracic area, giving rise to breasts and nipples
Accessory nipples occasionally develop, surgically removed
acute mastitis
Inflammation of the breast
Most commonly due to staph infection
Most common in lactating during first 6 months
Symptoms
Swelling, pain, redness, lumps
changes in breast tissue
Fibroadenoma
Fibrocystic changes
Breast cancer
fibrocystic breast disease
Most common of benign changes
Etiology
Unknown
More common in ages 20-40
Signs and symptoms
Pain
Lumps in breast
Size changes with menstrual period
Nipple discharge
Can rupture, induce inflammation
Ultrasound examination helpful in distinguishing a cystic from a solid mass
Treatment
Nothing if small cyst
Aspiration of cyst
Surgical excision if no aspiration
fibroadenoma
Benign
Well-circumscribed tumor of fibrous and glandular tissue
Is not precancerous
Common in young women
Painless
Size does not fluctuate
Treatment
Surgically excised
breast carcinoma
Most frequently diagnosed cancer in american women
Arise from duct-lobular unit
Duct and lobules
Age associated
Leading cause of death from ages 40 to 44
Second most common killer after lung cancer
Types
Familial
Sporadic
Risk factors
Hormonal factors = prolonged estrogen exposure
No children
not breastfeeding
Early menarche
Late menopause
Obesity
Alcohol
Sedentary lifestyle
Caucasian
Hormone replacement therapy
Occurs in both sexes, but rare in men, whose breasts are not subject to stimulation by ovarian hormones
familial breast cancer
Mutations in BRCA1 and BRCA2
Genes encode proteins for DNA repair
But only 5-10% of breast cancer
Increased risk for other cancers
Increases cancer risk in males as well
development of breast carcinoma
Early stages: too small to be detected by breast exam
Mammogram can identify carcinoma up to 2 years before detection by self breast exam
Cancer continues to grow, initially in situ; eventually become invasive
Metastasizes to axillary lymph nodes and distant sites
Problems with late metastasis - after you were treated initially
Early diagnosis allows prompt treatment and improves the cure rate
classification of breast carcinoma
CIS or invasive
CIS = 5 yr survival rate 93%
Invasion = most common at diagnosis
Degree of differentiation of tumor cells
Well-differentiated: cells that resemble normal breast tissue
Poorly-differentiated:
Biopsy of sentinel lymph node - first axillary lymph node
carcinoma treatment
Treatment
First modality is surgical excision
Lumpectomy removes cancer and rim of benign tissue for cancers less than 2 cm in diameter that have not spread to lymph nodes
Typically done in smaller with no metastasize
Radiation and chemotherapy are added for more extensive cancer
determining individual status of tumor
Presence or absence of hormone receptors
Estrogen receptors and progesterone receptors (PR) - can have one or both
Some cancers use hormones for growth
Positive tumors are associated with favorable prognosis
Anti Estrogenic agents block estrogen signaling and slow the growth of malignant cells in cancers that are ER and or/PR positive
Tamoxifen - slows down the growth, buying the patient more time
Amplification of HER2 (human epidermal growth factor receptor 2) - normal growth factor receptor
HER2 positive tumors more aggressive
HER2+ less responsive to hormone treatment - Like tamoxifen
However, can specifically target treatment for HER2
Triple negative = more difficult to treat
No ER receptor
No PR receptor
No HER2 amplification
No tools except chemotherapy and radiation
recurrent metastatic carcinoma
May appear many years after original tumor has been removed
Treatment is to control growth, relieve symptoms, and improve quality of life
Methods of treatment depend on the following factors
Hormone receptor status of tumor
Age of patient
Length that elapsed from initial treatment to appearance of metastasis
Pre- or postmenopausal
